JC-1664, 09/16 Notice of Post-Termination of Parental Rights Change in Placement 24748.437, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Notice of Post - Termination of Parental Rights Change in Placement Case No. 1. The child is subject to a guardianship order under 24748.427(3m)(a)1.-4., (am), or (b), Wis. Stats. 2. A. The placement will be changed on [Date] , which is ten (10) days after the notice was filed with the court, unless a hearing is scheduled on the matter. Give reason for new placement, why it is preferable to the present placement, and how it satisfies any treatment plan or permanency plan ordered by the court : B. The placement was changed on [Date] du e to emergency conditions necessitating an immediate change. This notice was filed within 48 hours after the emergency change in placement. Give reason for new placement, describe emergency conditions necessitating an immediate change, why it is preferable to the present placement, and how i t satisfies any treatment plan or permanency plan ordered by the court: 3. Name and address of new placement: 4. Reasonable efforts to place the child in a placement that enables the sibling group to remain together were made by . not required because the child does not have siblings in out-of-home care. not required because it would be contrary to the safety or well being of the child or any of the siblings because 5. The child is subject to the Indian Child Welfare Act. A. The placement is in accordance with the order of preference set forth in the Indian Child Welfare Act. OR B. There is good cause to depart from the order of placement preference in the Indian Child Welfare Act. 6. Within 10 days of filing of this notice, the court shall determine whether to schedule a hearing on the matter or shall approve the placement and enter an Order for Post-Termination of Parental Rights Change in Placement. DISTRIBUTION: 1. Court 2. Child 3 . Guardian/Legal Custodian 4. Case Worker/District Attorney/Corporation Counsel 5. 6. Placement Provider 7. Indian Custodian and Tribe (if any) 8. Other: Case Worker/District Attorney/Corporation Counsel Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com